颈胸段前路手术中喉返神经的应用解剖

An practical anatomy research of recurrent laryngeal nerve in the anterior approach of the cervicothoracic junction

目的:为颈胸段前路手术中对喉返神经的定位和保护提供解剖学基础。方法:解剖40具成人颈胸部尸体标本,在颈胸段前路手术区对喉返神经进行解剖、观察和测量。结果:(1)左、右喉返神经颈内脏筋膜穿入点范围分别水平对应T2/3椎间盘、T3椎体(占85.0%)和C7/T1椎间盘、T1椎体(占87.2%);(2)颈部左、右侧喉返神经分别为94.5%、59.6%走行在气管食管沟内;左、右喉返神经在迷走神经的返折点范围分别水平对应T3/4椎间盘、T4椎体(占75.0%)和T1/2椎间盘、T2椎体(占82.5%);(3)非返性喉返神经1例,喉返神经的分支与颈交感干有交通2例,均出现在右侧;(4)左喉返神经10.0%在甲状腺下动脉之前,57.5%在其之后,32.5%在其分支之间;右喉返神经35.0%在动脉之前,22.5%在其之后,42.5%在其分支之间。结论:在颈胸段前路手术中,左、右侧入路分别在T2/3和C7/T1椎间盘水平以上操作是较安全的,但以采取左侧入路为宜,应注意喉返神经的变异。

Objective：To provide an anatomic basis for the location and protection of the recurrent laryngeal nerve （RLN） in the anterior approach of the cervicothoracic junction（CTJ）.Method：Forty adult cadavers（80 sides） were collected at random for study.The RLN were dissected,observed and measured in the anterior region of the CTJ surgery.Resuit：（1）The entry point into the visceral fasciae of the left RLN locates at T2/3 disc,T3 level in 85.0% amd the right RLN at C7/T1 disc,T1 level in 87.2% respectively.（2）The rate of the left and right RLN location in the esophagotracheal groove was 94.5% and 59.6% respectively.The recurrent point of the left RLN located at 33/4 disc,T4 level of 75.0% with the right RLN at T1/2 disc,T2 level of 82.5%.（3）Non-recurrent laryngeal nerve appeared in 1 case;an anastomotic loop connecting the RLN and the cervical sympathetic chain appeared in 2 cases.Both of them were found on the right side. （4）On the right side,the RLN was found in front of the inferior thyroid artery in 35.0% of the cases,behind the artery in 22.5%,between the branches of the artery in 42.5%.On the left side,the RLN was found behind the artery in 57.5% ,in front of the artery in 10.0%,between branches the artery in 32.5%.Conclusion：It is safe for the right approach above C7/T1 disc in the anterior approach of the CTJ and for the left approach above T2/3 disc.The left-side approach is recommended in the anterior approach of the CTJ.The surgeon must be aware of the anomalies of the RLN in the CTJ surgery.